The present invention relates to medical billing systems and in particular to a charge router centrally collecting medical charge information and distributing it to different billing programs.
Hospitals and physicians deliver healthcare cooperatively, but as separate business entities. A patient staying in a hospital will typically receive separate bills from a treating physician, from the hospital, and from other sources as providing care may dictate. A physician's charges may cover the physician's professional services, the hospital's may cover use of hospital resources including rooms, equipment, and supplies, and other sources may include independent services run within the hospital, such as a home health care organization run by an independent entity. When separate physicians render services during a hospital stay, for example, a surgeon, an anesthesiologist, and a radiologist, each physician may generate charges resulting in separate bills. Even when physicians and hospitals work as a single business entity in an integrated delivery network, separate billing systems may be required by the payors.
Bills from each business entity are normally generated using computerized billing programs. These billing programs accept charges from submitting programs running on one or more remote terminals and operated by hospital or physician staff. The billing programs collect the charges, and edits and reviews the charges, ultimately producing a printed bill or its equivalent to be mailed or sent to a payor. Different business entities often use different the billing programs provided by different vendors and each having their own proprietary submitting programs and charge data protocols.
If charges are submitted to the wrong billing program, the erroneous charge may have to be manually deleted and the person originally submitting the charge instructed to resubmit the charge to the correct billing program. Manual corrections significantly delay the billing process, but automatic correction or deletion of erroneously directed charge information is hampered by lack of compatibility among billing and submitting programs. When a medical procedure generates charges destined for two different billing programs, a correction of an error in one charge detected by one billing program or made by the charge source does not automatically lead to a correction of the other charge.
Some charges may require a synoptic view of other related charges processed by other billing programs. For example, the charging of vaccination shots may be based on a count of the sequence number of the shot. If the shots are provided by different facilities having different billing systems, this count may be difficult to determine. Under certain reimbursement rules, different charge rules may apply to medical treatment received in a clinic depending on whether the treatment is shortly thereafter continued in a hospital. These rules are difficult to implement automatically if different billing programs are used by the clinic and hospital.
One possible solution is for all health care providers to adopt a single billing program or a common standard for billing programs that would allow them to freely intercommunicate. Such interoperability is not likely in the near future.